System and method for objective chromatic perimetry analysis using pupillometer

ABSTRACT

A pupillometer system includes a computer, a camera, and a testing compartment provided in the form of a substantially hemispheric bowl, where the substantially hemispheric bowl includes a plurality of chromatic beam emitters arranged about a visual field forming a plurality of visual field testing points. The plurality of chromatic beam emitters generate a first chromatic stimulus that stimulates a first anatomical structure of an eye and a second chromatic stimulus that stimulates a second anatomical structure of the eye where the first anatomical structure is different than the second anatomical structure. The camera records a pupil response of one or more eyes. The computer generates quantitative pupillary light reflex (PLR) measurements of the PLR in response to the stimuli, determines at least one PLR response ratio, and determines a state of health of the one or more eyes utilizing the at least one PLR response ratio.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation application of U.S. patentapplication Ser. No. 15/482,205 filed Apr. 7, 2017, which is adivisional of U.S. patent application Ser. No. 13/388,529 filed Feb. 2,2012, which is a 371 of International Patent ApplicationPCT/IL2010/000624 filed Aug. 2, 2010, which claims the benefit of U.S.Provisional Patent Ser. No. 61/230,733 filed Aug. 2, 2009, the entiredisclosure of which is hereby incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to a system, device and a method forvisual field testing and in particular, to such a system and method inwhich provides objective chromatic perimetry test or color vision testusing a pupillometer.

BACKGROUND OF THE INVENTION

A visual field test also known as perimetry, is a method of measuring anindividual's entire scope of vision that is, the central and peripheralvision. Such visual field tests attempt to map the visual field of eacheye individually. Visual field testing is most frequently used to detectany signs of glaucoma caused damage to the optic nerve. In addition itis useful for detection of central or peripheral retinal disease, eyelidconditions such as ptosis or drooping, optic nerve disease, and diseasesaffecting the visual pathways within the brain and associated with theCentral Nervous System (“CNS”).

The present prevailing method for visual field testing is performed asfollows: one eye of the patient is covered and the chin is placed on aconcave chin rest. The patient must look straight ahead at all times inorder to avoid testing the central vision rather than the periphery.Next, light flashes of various intensities and locations are projectedon the tested eye. Whenever the patient notices a flash he has to push abutton. After all the relevant looking angles are covered a computerprogram analyzes the patient's responses and assesses the visual fieldmap of the tested eye.

The principal stumbling block of the above procedure is itssubjectivity, requiring the patient to understand the testinginstructions, fully cooperate, and complete the entire test in order toprovide useful information. However, the patient cooperation maystrongly depend on his level of fatigue, wakefulness and attentiveness.This problem is especially severe in case of ill or elderly patients,younger children or patients with mental disabilities and developmentaldelay. Consequently, the test results obtained by the current method maynot be accurate and may lead to false medical diagnosis. Moreover, theresults may not be repeatable, which does not allow for reliable andeffective tracking of the patient's medical condition.

Additional tests to assess the state of the eye is the Pupillary LightReflex (“PLR”) to provide clinical signs of the condition associatedwith the CNS. The PLR test the pupil response, namely constriction, bytesting the pupil's stimulus response in each eye where a healthy eye isindicative of symmetric constriction of both pupils. A quantitativemeasurement of a PLR may be obtained using a pupillometer.

Pupil perimetry utilizes a pupillometer together with a stimulusarrangement similar to that of a perimeter to measures the latency andamplitude of the constriction of the pupil in response to a stimuli,usually in the form of a spot (“small-area”) flashes of light that isdirected to different locations on the retina.

The pupillary response to spatially-localized luminance increments hasbeen used as an indicator of glaucomatous retinal damage, but thesmall-area stimuli used in pupil perimetry may target small retinalareas that only weakly stimulate a PLR, and may fail to stimulate a PLRif the small retinal area that is being stimulated by light has beendamaged by glaucoma. standard pupil perimtry testing produce largevariations in pupil response amplitude among patients and the changes insensitivity of the pupil response with the retinal location of thesmall-area light stimulus have also limited the usefulness of suchmeasurements.

Pupillometer based objective visual tests have been recited in somereferences, based on an achromatic beam stimulus which is applied atvarious angles, for example U.S. Pat. No. 5,610,673 to Rafal et al, U.S.Pat. No. 7,524,064 to Wyatt, U.S. Pat. No. 7,258,444 to Gorin. However,these methods fail to achieve neither accurate nor repeatable visualfield mapping due to its susceptibility to time variations in the humanocular system and to differences in the behavior of the ocular system ofdifferent patients.

SUMMARY OF THE INVENTION

There is an unmet need for, and it would be highly useful to have, asystem and a method for objective chromatic perimetry analysis usingpupillometer that is adept at providing an indication of the state ofhealth of the eye and in particular identifying damage to the eye. Thepresent invention overcomes the deficiencies of the background byproviding a system and method that provides an objective test andanalysis that is able to quantify an individual's state of health of theeye. The system and method overcome the deficiencies of the art byproviding individual specific indication of problem areas of the eye inobtaining measurements that are relative to an individual's field ofvision at specific visual field testing points, rather than full fieldtest provided by the prior art. Moreover the objective test of optionalembodiments of the present invention provides for a quick test that doesnot require patient specific interaction or input, that is subjectiveand often unreliable or misleading. Rather the test of the presentinvention most preferably measures a subject's PLR without a subject'sinput ensuring the objective nature of the test, hence more reliable andrepetitive.

An optional embodiment of the present invention provides a system andmethod for testing an individual's response to at least two or morestimuli that are individually associated with the anatomical tissue,cells, ganglion, or the like anatomical structures comprising the eye,for example including but not limited to ganglion, most preferably therods and cones, and elucidating a ratio reflective of the relativeresponse of the stimuli utilized. For example the ratio utilized maycomprise at least two response measurements associated with the groupcomprising of rods, cones, ganglion in any combination thereof, thereinproviding for a ratio selected from the group consisting of rods tocones; rods to ganglion, cones to ganglion, or the like.

An optional embodiment of the present invention provides a system andmethod for testing an individual's response to at least three or morestimuli that are individually associated with the anatomical tissue,cells, ganglion, or the like anatomical structures comprising the eye,for example including but not limited to ganglion, rods and cones, andoptionally elucidating at least one or more ratio reflective of therelative response of the stimuli utilized; more preferably elucidatingat least two ratios reflective of the relative response of the stimuliutilized. For example, at least two ratios utilized may for example beany combination of the ratio selected from the group comprising rods toganglion, cones to ganglion, rods to cone, ganglion to rods, ganglion tocones, or the like. Optionally the evaluation of the eye may be providedby a utilizing a ratio comprising a common denominator for example, aratio of rods to ganglion may be compared and evaluated with respect tothe ratio of cones to ganglion.

A preferred embodiment of the present invention introduces at least twoor more stimuli comprising at least one cone specific stimulus and atleast one rod specific stimulus, to a plurality of location hereinreferred to as the visual field points (‘VFP’) of at least one eye, andmeasuring the PLR response, namely pupil constriction, via apupillometer; and comparing the PLR response, at a given VFP, of therespective stimulus to obtain a ratio indicative an individual's stateof health of the eye.

For example, stimulus that is geared toward the rod and stimulus isprovided in the form of chromatic light flashes comprising a shortwavelength most preferably a narrow beam within the blue spectrum range,for example including but not limited to wavelength of about 450 nm, 455nm, 460 nm, 465 nm, 470 nm, 475 nm, 480 nm, 485 nm, 490 nm or the like,most preferably the stimuli utilized is about 485 nm.

Optionally the cone specific stimulus is provided in the form ofchromatic light flashes comprising a long wavelength most preferablynarrow beam within the red spectrum range, for example including but notlimited to wavelength of about 630 nm, 635 nm, 640 nm, 645 nm, 650 nm,655 nm, 660 nm, 665 nm, 670 nm, 675 nm, 680 nm, 685 nm, 690 nm, 695 nm,700 nm any combination thereof or the like.

Optionally and preferably the ratio obtained according to optionalembodiment of the present invention is a ratio of cone specific stimulusresponse to a rod specific stimulus response.

Optionally the ratio utilized may be region specific about the differentvisual field points tested. For example, the central field points of theVFP may optionally utilize a ratio determined by rod specific stimulusresponse to cone specific stimulus response, while the peripheral fieldpoints may utilize a ratio of cone specific stimulus response to a rodspecific stimulus response, as an indication of eyes state of health inthe particular region and/or visual field point.

Optionally the ratio provided by the system and method of the presentinvention provides for individual specific measurements, reducevariability between the tested population, an indicator of anindividual's internal state of balance associated with the sympatheticand parasympathetic state. Optionally utilization of the ratio accountsfor and reduces variability due to light scattering and supranuclearinhibition. Optionally the ratio according to the present invention mayaccount for the variability among the population pupil size, thereinproviding a standardized measurement relative to an individual ratherthan a population. Optionally and preferably the ratio is adept atassessing and providing an indication of the extent of an individual'svisual field rim.

The present invention resolves the above background art limitations byproviding, in at least some embodiments, a reliable and objective visualfield testing, that is reliable and repeatable.

An optional embodiment of the present invention provides a decisionsupport system for diagnosing eye and/or retinal damage by assessing asubject's PLR in response to at least two or more chromatic stimuli todefine a ratio indicative of the underlying state of health of thetested eye.

Optionally the at least two stimuli is composed of a first stimuluscomprising a short wavelength chromatic stimulus and a second stimuluscomprising a long wavelength chromatic stimulus, and wherein the ratiois the determined by evaluating the long wavelength PLR response withrespect to the short wavelength PLR response of the tested eye.

Optionally the first stimulus is within the blue range from about 450 nmto about 490 nm, optionally and preferably about 475 nm, more preferably480 nm and most preferably 485 nm. Optionally the second stimulus iswithin the red range from about 635 nm to about 700 nm, optionally andpreferably about 650 nm.

An optional embodiment of the present invention provides a system forobjective chromatic perimetry test comprising a pupillometer, a processand a camera that most preferably does not require subject input:

a. the pupillometer comprising:

a testing compartment provided in the form of a hemispheric bowl,wherein an inner surface of the bowl comprises a plurality of openingsforming form a plurality of visual field testing points; and

wherein the hemispheric bowl may be associated with a plurality ofchromatic beam emitters arranged about the visual field such that theyare disposed over the plurality of visual field testing points; andwherein the chromatic emitters provide for generating a chromaticstimuli about the visual field points; and wherein

the stimuli comprises at least two different stimulus selected from thevisual spectrum spanning from about 390 nm to about 750 nm wherein thedifferent stimulus are individually characterized by their individualstimulus parameters including wavelength, duration, delay, andintensity; and

wherein the outer perimeter of the inner surface of the testingcompaituient further comprises a light adaptation emitter wherein theadaptation emitter comprising at least one or more chromatic beamemitters; and

The inner surface further comprising a fixation point opposite asubject's line of sight; and

The bowl further comprising at least one or more opening for at leastone or more camera provided for recording the pupil contraction inresponse to the stimuli; and

b. The processor provided for controlling the chromatic beam emitters,the stimulus parameters and the visual field points; and wherein theprocessor processes data associated with and generated by the stimulusand camera.

Optionally and preferably the device according to the present inventionmay be adapted to provide for color vision testing.

Optionally the stimuli may include a first stimulus characterized inthat it may be a short wavelength chromatic beam and a second stimuluscharacterized in that it may be a long wavelength chromatic beam.

Optionally the stimuli comprises up to three individual stimulus.Optionally the first stimulus may be provided in the form of a chromaticbeam in the blue wavelength range centered at about 480 nm or about 485nm. Optionally the chromatic beam stimulus may be selected from about450 nm to about 495 nm comprises a blue wavelength beam selected fromabout the group consisting of about 450 nm, 455 nm, 460 nm, 465 nm, 470nm, 475 nm, 480 nm, 485 nm, 490 nm, 495 nm, 500 nm or any combinationthereof.

Optionally the second stimulus may be a chromatic beam in the redwavelength range centered at about 640 nm or about 620 nm. Optionallythe second stimulus chromatic beam may be selected from about 590 nm toabout 750 nm and comprising red wavelength selected from the group forexample including but not limited to about 610 nm, 615 nm, 620 nm, 625nm, 630 nm, 635 nm, 640 nm, 645 nm, 650 nm, 655 nm, 660 nm, or anycombination thereof.

Optionally the first stimulus and the second stimulus are adapted toindividually stimulate a specific anatomical structure of the eye.Optionally the first stimulus may be adapted to stimulate rods andganglion while the second stimulus may be adapted to stimulate cones.

An optionally the stimulus may be characterized in that it may bespecific an anatomy of the eye; and wherein the system of the presentinvention comprises at least two stimuli that may be generated tosimulate at least two anatomical structures of the eye.

Optionally a light adaptation emitter comprises three chromatic beamemitters adapted to produce a visible color about the inner surface ofthe bowl of the test compartment.

Optionally the hemispheric bowl may be provided in the form of aganzfeld dome or a Goldmann, or static perimeters.

Optionally the plurality of chromatic beam emitters or the plurality ofopenings are further provided with a controllable shutter forcontrolling the size and shape of the generated stimulus. Optionally andpreferably the shutter size may be adapted to provide a stimulus havinga substantially circular formation with a diameter from about 0.8 cm toabout 2 cm. Optionally and preferably shutters may be controllable withthe processors.

Optionally the plurality of chromatic beam emitters are provided in theform of a Light Emitting Diode (‘LED’). Optionally the LED provides aspecific chromatic beam characterized in that it may be specific to ananatomy of the eye. Optionally the LED may provide a plurality ofoptional specific chromatic beams characterized in that each beam may beindividually specific to an anatomy of the eye.

Optionally the chromatic beam emitters or the openings about the innersurface of the test compartment are arranged to provide from about 13 toabout 256 visual filed testing points about the vertical and horizontalplanes of the hemispheric bowl. Optionally each of the visual fieldpoint comprises at least one chromatic beam emitters in the form of aLED that may provide a plurality of optional specific chromatic beams.

Optionally the device according to the present invention may beconfigured such that each of the visual field points may comprise atleast two chromatic beam emitters in the form of a LED characterized inthat each LED provides a specific chromatic beam.

Optionally the device according to the present invention may beconfigured such that each of the visual field point comprises at leastthree chromatic beam emitters that may optionally be provided in theform of a LED.

Optionally the chromatic beams may be further characterized in that eachbeam may be individually specific to an anatomic structure of the eye,for example including but not limited to the rods and cones, ganglion.

Optionally the fixation point may be disposed at about the pole of thehemispheric bowl and may comprise up to four fixation points about thecenter.

Optionally the system according to the present invention may comprise atleast one and up to four cameras, for objectively recording the PLR ofsubject. Optionally the system may comprise at least one, or at leasttwo, or at least three or at least four cameras. Optionally the PLR maybe recorded for each eye utilizing at least two cameras.

Optionally the shutter may for example be provided in the form of astatic shutter or a dynamic shutter, or a combination thereof or thelike.

Optionally the stimulus duration or delay may be controllably set to beany single value or range of values selected from about 100 ms to about4000 ms.

Optionally the stimulus intensity used with the system and methodaccording got the present invention may be controllably set to be anysingle value or range of values from about from 3.98×10⁻⁸ ed/m² up toabout 3.98×10² cd/m².

An optional embodiment of the present invention provides for a methodfor determining the state of health of an eye with a pupillometerproviding an objective chromatic perimetry analysis test, where mostpreferably a subject's input is not required and therefore the test ispreformed and results are analyzed independently of subject's input.Most preferably the a measurement of the PLR in response to chromaticbeam stimuli is presented at a plurality of visual field testing points,and defining a ratio of the measured PLR at each of the plurality ofvisual field testing points in response to a first chromatic beamstimulus relative to a response to a second chromatic beam stimulus,wherein the first and second stimulus are characterized by parametersfor example including but not limited to wavelength, duration, delay,and intensity; and wherein the stimuli wavelength are selected from thevisual spectrum spanning from about 390 nm to about 750 nm.

Optionally the first chromatic beam stimulus may be a short wavelengthbeam and the second chromatic beam stimulus may be a long wavelengthbeam. Optionally the first chromatic beam may be within the bluewavelength spectrum range centered at about 480 nm or about 485 nm; andthe second chromatic beam may be a chromatic beam within the redwavelength spectrum range centered at about 640 nm or about 620 nm.

Optionally the ratio of the PLR measured with the long wavelengthresponse relative to the PLR measured with the short wavelengthresponse. Optionally the first and second chromatic beam stimuli arespecific to different anatomical structure within the eye, for exampleincluding but not limited to rods, cones and ganglion. Optionally thefirst stimuli may be directed at the rods; and the second stimuli may bedirected at the cones.

Optionally the first stimulus may be provided for a duration of about 1s (one second), with an intensity of about 3.98×10⁻⁸ cd/m², with aninter-stimulus pause of about 891 ms (milliseconds); and the secondstimulus may be provided for a duration of about 1 s (one second), withan intensity of about 3.98×10⁻⁸ cd/m², with an inter-stimulus pause ofabout 1023 ms (milliseconds).

Optionally the first and second stimulus may be presented to a subjectat least once and up to three time for each visual field testing point.

Most preferably the ratio may be mapped to a visual field map.Optionally and preferably the ratio or map thereof may be indicative ofthe state of health of anatomical structures correlated with individualvisual field points.

Optionally the ratio that may be indicative of underlying normal and/orhealthy anatomical structures are provided by the following field pointcoordinates and expected ratio (0°, nasal, 0.50); (10°, nasal, 0.41);(10°, temporal, 0.45); (10°, up, 0.48); (10°, down, 0.43); (20°, nasal,0.40); (20°, temporal, 0.33); (20°, up, 0.38); (20°, down, 0.39); (30°,nasal, 0.50); (30°, temporal, 0.44); (30°, up, 0.5); (30°, down, 0.40).Optionally the ratios may be indicative of the state of health of an eyeassociated with glaucoma, and retinitis pigmentosa (RP). Optionally theratios may be indicative of the state of health of an eye associatedwith color blindness.

Optionally and preferably the test according to the present inventionmay be performed with background luminance providing for lightadaptation. Optionally and preferably background luminance and lightadaptation may be controllable, preferably provided to facilitatetesting of an anatomical structure of the eye. Optionally the backgroundluminance may be any one value or a range of values selected from about1 cd/m² to about 20 cd/m². Optionally background luminance may be about2.7 cd/m² or about 17.1 cd/m² (about 5 foot-lambert). Optionally theonset of light adaptation may be controlled and therefore provided at aplurality of optional portions of the test or at different controllableperiods of the test, for example including but not limited to betweenstimulus presentations, between visual field testing points, betweenvisual field rings, or any combination thereof or the like.

An optional embodiment of the present invention provides device in theform of a pupillometer for performing an objective chromatic perimetrytest, that most preferably does not require a subject's input, thedevice comprising a pupillometer testing compartment and at least one ormore camera, the pupillometer testing compartment comprising:

the testing compartment provided in the form of a hemispheric bowl,wherein an inner surface of the bowl comprises a plurality of openingsforming form a plurality of visual field testing points; and

wherein the hemispheric bowl may be associated with a plurality ofchromatic beam emitters arranged about the visual field such that theyare disposed over the plurality of visual field testing points; andwherein the chromatic emitters provide for generating a chromaticstimuli about the visual field points; and wherein

the stimuli comprises at least two different stimulus selected from thevisual spectrum spanning from about 390 nm to about 750 nm wherein thedifferent stimulus are individually characterized by their individualstimulus parameters including wavelength, duration, and intensity; and

wherein the outer perimeter of the inner surface of the testingcompartment further comprises a light adaptation emitter wherein theadaptation emitter comprising at least one or more chromatic beamemitters; and

The inner surface further comprising a fixation point opposite asubject's line of sight; and

The bowl further comprising at least one or more opening for at leastone or more camera provided for recording the pupil contraction inresponse to the stimuli.

An optional embodiment of the present invention provides for determininga ratio of the PLR response at individual visual field testing pointsbased on a response to at least two or more, or three or more, or fouror more chromatic beam stimuli presented to a tested eye. Optionally adifferent ratio may be determined based on how the eye was stimulatedfor example each eye individually, both eyes in turn, or both eyessimultaneously.

Unless otherwise defined the various embodiment of the present inventionmay be provided to an end user in a plurality of formats, platforms, andmay be outputted to at least one of a computer readable memory, acomputer display device, a printout, a computer on a network or a user.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. The materials, methods, andexamples provided herein are illustrative only and not intended to belimiting. Implementation of the method and system of the presentinvention involves performing or completing certain selected tasks orsteps manually, automatically, or a combination thereof. Moreover,according to actual instrumentation and equipment of preferredembodiments of the method and system of the present invention, severalselected steps could be implemented by hardware or by software on anyoperating system of any firmware or a combination thereof. For example,as hardware, selected steps of the invention could be implemented as achip or a circuit. As software, selected steps of the invention could beimplemented as a plurality of software instructions being executed by acomputer using any suitable operating system. In any case, selectedsteps of the method and system of the invention could be described asbeing performed by a data processor, such as a computing platform forexecuting a plurality of instructions.

Although the present invention is described with regard to a “computer”on a “computer network”, it should be noted that optionally any devicefeaturing a data processor and/or the ability to execute one or moreinstructions may be described as a computer, including but not limitedto a PC (personal computer), a server, a minicomputer, a cellulartelephone, a smart phone, a PDA (personal data assistant), a pager. Anytwo or more of such devices in communication with each other, and/or anycomputer in communication with any other computer, may optionallycomprise a “computer network”.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is herein described, by way of example only, withreference to the accompanying drawings. With specific reference now tothe drawings in detail, it is stressed that the particulars shown are byway of example and for purposes of illustrative discussion of thepreferred embodiments of the present invention only, and are presentedin order to provide what is believed to be the most useful and readilyunderstood description of the principles and conceptual aspects of theinvention. In this regard, no attempt is made to show structural detailsof the invention in more detail than is necessary for a fundamentalunderstanding of the invention, the description taken with the drawingsmaking apparent to those skilled in the art how the several forms of theinvention may be embodied in practice.

In the drawings:

FIG. 1A-B are schematic block diagrams of an exemplary system accordingto the present invention;

FIG. 2A-C are a schematic illustrative diagrams of visual field pointsshowing alternative configurations for the chromatic beam emittersaccording to optional embodiments of the present invention;

FIG. 3 is a flowcharts of an exemplary method according to the presentinvention;

FIG. 4A-C are a schematic illustrative diagrams of a visual fileddiagram showing of results obtained from health normal eyes within the50th, 75th and 25th percentiles. FIG. 4A present measured results withthe long wavelength stimuli within the red spectrum, about 610 nm,associated with the Cones. FIG. 4B present measured results with theshort wavelength stimuli within the blue spectrum, about 485 nm,associated with the Rods. FIG. 4C presents the long wavelength to shortwavelength ratio according to the present invention as obtained betweenthe results of FIG. 4A to FIG. 4B.

FIG. 5A-C are a schematic illustrative diagrams of a visual fileddiagram showing of results obtained from subjects presenting withretinitis pigmentosa (‘RT). FIG. 5A present measured results with thelong wavelength stimuli within the red spectrum, about 610 nm,associated with the Cones. FIG. 5B present measured results with theshort wavelength stimuli within the blue spectrum, about 485 nm,associated with the Rods. FIG. 5C presents the long wavelength to shortwavelength ratio according to the present invention as obtained from theresults presented in FIG. 5A to FIG. 5B.

FIG. 6A-D are a schematic illustrative diagrams of a visual fileddiagram showing of results obtained from subjects presenting withglaucoma. FIG. 6A present measured results with the long wavelengthstimuli within the red spectrum, about 610 nm, associated with theCones. FIG. 6B present measured results with the short wavelengthstimuli within the blue spectrum, about 485 nm, associated with theRods. FIG. 6C presents the long wavelength to short wavelength ratioaccording to the present invention as obtained from the resultspresented in FIG. 6A to FIG. 6B. FIG. 6D provides an additional view ofFIG. 56 on a background of the traditional visual field map for thetested glaucoma patient.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The principles and operation of the present invention may be betterunderstood with reference to the drawings and the accompanyingdescription. The following reference labels listed below are usedthroughout the drawings to refer to objects having similar function,meaning, role, or objective.

-   -   100 Pupillometer;    -   101 Pupillometer test compartment;    -   102 Pupillometer head and chin support frame;    -   103 Pupillometer ocular(s);    -   104 hemispheric surface;    -   105 chromatic beam emitters;    -   105 a first stimuli chromatic beam emitters;    -   105 b second stimuli chromatic beam emitters    -   105 c light adaptation RGB emitter;    -   106 camera;    -   107 focal fixation point marker;    -   108 shutters;    -   109 computer;    -   110 power supply;    -   112 light adaptation emitter;    -   120 objective chromatic perimetry system;    -   200 visual field map arrangement;    -   201 visual filed points    -   202 0° field map ring;    -   204 10° field map ring;    -   206 20° field map ring;    -   208 30° field map ring;    -   210 multi source chromatic beam emitter configuration;    -   220 single source chromatic beam emitter configuration.

Referring now to the drawings, FIGS. 1A-B show schematic illustrativediagrams of system 120 of the present invention for objective chromaticperimetry analysis comprising a pupillometer 100 and a computer 109.Pupillon-ieter 100 is utilized to perform a Pupillary Light Reflex(“PLR”) test of at least one eye where the PLR is measured by presentingthe tested eye with stimulus and measuring the pupil's constrictionresponse. Pupillometer 100 comprises a testing compartment 101 mostpreferably in the form of a Ganzfeld, is a hemispherical shaped bowl toallow for testing of the full visual field of a subject. Preferablytesting compartment 101 comprises an inner surface 104 forming a screenonto which the stimuli is presented, a plurality of chromatic beamemitters 105, focal fixation point marker 107 and camera 106.

Test compartment 101 preferably comprises and incorporates and isintegrated with inner surface 104, where surface 104 is associated withat least one or more preferably a plurality of chromatic beam emitters105 that preferably provide for generating and presenting the stimulusfor a which a response is measured. Focal fixation point marker 107provides a subject with a fixation point during the test, optionally andpreferably fixation point comprises 4 beams of red light arranged abouta central point on surface 104, most preferably the pole of surface 104.Camera 106, for example in the form of a CCD camera or a the likedigital camera, may be provided within test compartment and ispreferably directed toward the tested eye so as to allow for visualizingand recording the pupil during testing therein providing for recordingthe PLR of the tested eye. Most preferably at least one camera 106, maybe disposed within test compartment 101, optionally at least one and upto four cameras may be provided and arranged within test compartment 101to better identify the PLR of the tested eye. Optionally two cameras'may be utilized to record a single tested eye. Optionally two camerasmay be utilized to record a subject PLR when both eyes are testedsimultaneously. Optionally up to four cameras may be utilized to recorda subject PLR when both eyes are tested simultaneously, wherein at leastone camera and more preferably at least two cameras are provided torecord the PLR of each tested eye. Most preferably camera 106 transmitsand records the subject's eye during testing sending data to computer109 or the like processor for analysis, for example including but notlimited to a server, PDA, smart phone or the like device comprising aprocessor. Most preferably data obtained by at least one or more camera106 is processed with computer 109 via dedicated software.

Optionally camera 106 may be attached, coupled or otherwise associatedwith surface 104. Most preferably camera 106 continuously capturesimages of at least one of the tested eye, or of both eyes for examplewhen the consensual reflex is tested. Optionally camera 106 may besubstantially simultaneously controlled with emitters 105 by computer109. Most preferably camera 106 continuously transfers images of thepupil to computer 109 at a rate of about 50 shots-per-second, or 40shots per second or the like. Optionally the pupillary images may beprovided and/or transferred in various forms for example including butnot limited to stills, common digital video format or the like as isknown in the art. Optionally camera 106 may communicate and/or transferdata to computer 109 through a plurality of optional communicationtechnology and/or protocols for example including but not limited towired, wireless, cellular, optical or acoustic communication protocolsfor example including but not limited to infrared, Bluetooth, wife orthe like.

Optionally computer 109 may further provide for a decision support toolsassociated with the sate of health of the eye. Optionally a decisionsupport tool may provide physician and/or clinicians with assistance inanalyzing and determining the state of health of the tested eye based onthe results obtained with the system and method of embodiments of thepresent invention.

FIG. 1B provides a cross-section views of an schematic optional testcompartment 101 of system 120. Test compartment 101 may be provided asan opaque chamber that preferably serves to block interference ofexternal illumination during testing. Optionally and preferably thefront side of test compartment 101 forms a support frame 102 that iscapable of receiving the patient's head while supporting the chin andforehead. Preferably the middle section of support frame 102 comprisesat least two openings 103 that serve as oculars allowing a subject toview the presented stimulus about surface 104. Optionally and preferablyeach ocular 103 may be controlled by computer 109. For example whentesting only the subject's right eye the right ocular is controllablyplaced in the open position by computer 109 while the left ocular isplaced in the closed position, allowing for isolating the right eye andmeasuring the PLR of the right eye only.

The rear part of testing compartment 101, is optionally and preferablyprovided in the form of a semispherical bowl, ganzfeld dome, goldmannperimeter or the like surface 104 that is preferably made of areflective material. Most preferably at least one and more preferably aplurality of chromatic beam emitters 105, optionally in the form of aLight Emitting Diode (‘LED’) are located about, attached or otherwisecoupled to surface 104. Optionally emitters 105 may be integrated withsurface 104. Most preferably emitters 105 are provided in the form of achromatic LED providing a narrow spectrum light source in the visiblerange. Optionally the arrangement of emitters 105 about surface 104 maybe controlled, for example a single multi spectrum LED may be placedabout the stimuli location field point as shown in FIG. 2B. Optionallyat least two or more preferably a plurality of emitters 105, for examplea spectrum specific LED, may be arranged about surface 104 as shownfield map 210 in FIG. 2A, wherein each emitter 105 is specific to aparticular chromatic stimulus source that is being tested. Mostpreferably emitters 105 provide for stimulating the tested eye inparticular the retina by illuminating a portion of the eye with achromatic narrow light beam. Optionally emitters 105 may be configuredabout surface 104 in a dense grid structure, optionally and preferablycorresponding to visual field map having a plurality of point beingtested, from about 13 to at least 256 or more as show in FIG. 2C.Optionally a plurality of emitters 105 may be associated with orintegrated with internal shutters to control stimulus parameters forexample the shape, size, timing of the stimulus.

Optionally surface 104 may comprise a plurality of opening and shutters108 arranged similarly to that of emitters 105 as shown in FIGS. 2A-C,optionally and preferably corresponding to the resolution of the visualfield points tested. Optionally shutters 108 and/or openings may becontrollable with computer 109 to control at least some parameters ofthe stimuli presented to the tested eye, for example includingparameters such as the shape and size of the stimulus to be provided.Optionally screen 104 may be provided with a finite number, for examplethree, of controllable opening sizes and or shapes with which thepresented stimulus may be controlled. Optionally shutter 108 may providea stimulus size of bout 0.05 cm to about 2 cm in diameter. For example,the stimulus shape may be chosen from circular with a diameter of about1 cm, or a square with each side having a length of about 0.95 cm.

Most preferably surface 104 comprises a focal point marker 107 at aboutthe central point of the surface 104. Optionally and preferably marker107 is provided in the form of a dim red light, that may serve as afocal marker for the tested patient. Optionally the focal fixation pointmarker may comprise at least one and up to four dim red light sourceabout a central point. During testing a subject is asked to look atfocal marker 107 providing a common reference point that is repeatablepoint for all subjects and/or eyes tested. Optionally at a plurality offocal markers 107 may be utilized with Pupillometer 100.

Optionally light adaptation emitter 112 optionally and preferably.comprising at least one and up to three chromatic beam emitters 105 c,optionally in the red, green and blue range wavelength, may be disposedabout the outer perimeter of test compartment 101 near head supportframe 102, for example along the inner surface 104.

Optionally light adaptation emitter 112 may be attached to the frontwall of test compartment 101. Preferably when light adaptation emitter112 is activated it illuminates surface 104 providing for lightadaptation as described in stage 302 of FIG. 3 where the lightadaptation used may prime particular anatomical structure of the eyetherein facilitating the performed test.

Optionally light adaptation emitter 112 may provide for fullyilluminating screen 104 in any chromatic wavelength comprising acombination of at least one and up to three chromatic beam emitters 105c. Optionally stimulus control with light adaptation emitter 112 may beprovided with controllable shutters 108 to selectively emit the lightproduced by emitter 112 to select field points 201 corresponding toselected shutters 108 that are in the open position, where mostpreferably control of the shutter 108 is provided with computer 109.Optionally light adaptation emitter 112 may provide for a color fieldperimetry test for example for testing color blindness about individualfield points as shown in FIG. 2C.

Optionally and preferably computer 109 may provides for overall controlof pupillometer 100 and system 120.

Power Supply unit 110 is most preferably coupled with main power whichfor providing system 120. Preferably power supply 110 converts and/orgenerates a stabilized DC (Direct Current) voltages that are requiredfor proper operation of system 120 and varying component of pupillometer100.

FIGS. 2A-B provide illustrative diagrams of a 13 point visual field map200 showing optional alternative configurations for the chromatic beamemitters 105, for each point 201, in the form of a multi sourcechromatic beam emitter configuration 210, FIG. 2A, in the form of asingle source chromatic beam emitter configuration 220, FIG. 2B, eachaccording to optional embodiments of the present invention.

FIG. 2A shows visual field 210 comprising a plurality of emitters 105 ateach visual field points 201, optionally accounting for individualemitter 105, where each emitter 105 may provide for a specific chromaticbeam stimulus at the a given visual field point about visual field 210,at each point 201. Optionally at least two or more chromatic beamemitters 105 may be provided at each visual field point 201. For exampleemitters 105 a and 105 b may be provided to stimulate the tested eye atthe same visual field point, for example at 30° field map ring 208. Forexample beam emitter 105 a may provides a short wavelength chromaticstimulus, for example in the blue range at about 475 nm, while emitter105 b may provide a long wavelength chromatic stimulus, for example inthe red range at about 650

MIL FIG. 2B shows visual field 220 comprising a single emitter 105 atindividual visual field points 201, where optionally emitter 105 mayprovide at least two or more preferably a plurality of optionalchromatic beams at varying wavelengths. For example a single beamemitter 105 may provides both a short wavelength chromatic stimulus inthe blue range, for example about 475 nm, and a long wavelengthchromatic stimulus in the red range, for example about 650 nm, at agiven visual field point 201 about visual field 220, for example at 20°field map ring 206, as shown.

FIG. 2C provides a depiction of an optional map of a visual filed mapwith a plurality of points that may be used to stimulate a subject's eyeduring a test protocol according to the present invention. Optionallythe number of field points 201, utilized with the system and method ofthe present application may vary from about 13 points to about 256points or more, Optionally any number of points in a circular gridstructure, about a. visual field may be used to test specific areas of asubject's eye, for example a 64 point visual field map. Optionally thenumber of tested field point utilized is proportional to the requiredresolution of the filed map of the test protocol or the required test.Optionally each field ring 202, 204, 206, 208 is separated by about 10°degrees a 30° degree, another option is that each point within the ringis spaced and/or separated by at about 5° degrees resulting in higherresolution with more point of examination in the visual field.

FIG. 3 shows a flowchart of an exemplary method according to the presentinvention for objective chromatic perimetry analysis using pupillometertherein providing an objective, repeatable and quick test.

In stage 301, a subject is prepared for the test where at least one eyeof a subject is introduced to pupillometer 100 wherein the subject'sforehead and chin are supported by support frame 102 while the testedeye is focused onto focal fixation point marker 107 through at least oneocular 103. Optionally and preferably test preparation may includeselecting the test sequence to be preformed via computer 109 utilizingdedicated software.

Most preferably testing sequence, comprising the stimulus parameters,the visual field points tested, tested eye(s), light adaptation and thenumber times a stimulus is presented or number of stimulus sessions, maybe preset and automated according to the test being performed and/oraccording to the test's objectives. Optionally and preferably a testingsequence may be created manually, altered, changed, abstracted orotherwise controlled by an operator via dedicated software associatedwith computer 109 adapt at controlling pupillometer 100.

Most preferably stimulus parameters for example including but notlimited to luminance, intensity, duration, and wavelength may becontrolled by the operator via computer 109.

Optionally and preferably the visual field points stimulated (FIG. 2A-C)and the order and sequence by which they may be presented to a subjectis automatically controlled or manually controlled via computer 109.

Optionally and preferably the number of stimuli provided at each of thevisual field testing points may also be automated, manually or otherwisecontrolled via computer 109.

Optionally and preferably the test sequence and/or protocol may beperformed on a single eye, on each eye individually one at a time, mayalternate between both eyes, both eyes tested simultaneously, or anycombination thereof. Optionally control of which eye is tested duringthe testing sequence is controlled via computer 109 and oculars 103.Optionally computer 109 provides for controlling oculars 103 accordingto the prescribed and/or selected testing sequence.

An objective chromatic perimetry test according to the present inventionis initiated by simultaneously initiating and presenting a subject withstimulus as described in stage 303 below, while continuously capturing,recording and measuring a subject's PLR response to the presentedstimuli in stages 304 and 305. Most preferably in stage 304 at least oneor more camera 106 disposed within testing compartment 101 aresimultaneously activated with the image capture and PLR analysisprovided with computer 109.

In stage 302 following the pupillometer preparation and subjectpreparation, test compartment 101 is provided with a light adaptationwhere the background luminance, via light adaptation emitter 112comprising at least one and up to three chromatic beam emitters 105 c,of the test compartment is controlled and to facilitate and/or prime theeye for testing particular anatomical structures of the eye.

For example a background luminance of 2.7 cd/m² (candela per squaremeter) may be utilized to prime for testing of the rods, cones andganglion. For example a background luminance equal to about 5foot-lambert or 17.1 ed/m² (candela per square meter) may be utilized tospecifically prime testing conditions for testing cones whilesuppressing rods. Most preferably light adaptation is providedthroughout the test sequence and/or protocol.

Next in stage 303, the stimulus is provided to the tested eye and wilecamera 109 provides for capturing the images and video of subject's PLR.The stimulus and test sequence is preferably controlled with computer109, and may be altered based on the type of test and test objective.

Optionally and preferably stimuli parameters are controllable forexample including but not limited to wavelength, duration of stimulus,inter-stimuli delay, size, shape, luminance, intensity or the likeparameters may be controlled with computer 109. Optionally test stimuluswavelength may be any chromatic beam from the visible spectrum spanningfrom about 390 nm to about 750 nm, for example including but not limitedto violet range (about 380 nm to about 450 nm), blue range (about 450 nmto about 475 nm), cyan range (about 476 nm to about 495 nm), green range(about 495 nm to about 570 nm), yellow range (about 570 am to about 590nm), orange range (about 590 nm to about 620 nm), red range (about 620nm to about 750 nm), in any combination thereof or the like. Optionallystimuli duration and/or delay may be from about 100 ms to about 4000 ms,for example including but not limited to about 100 m, about 200 ms,about 300 ms, about 400 ms, about 500 ms, about 600 ms, about 700 ms,about 800 ms, about 900 ms, about 1000 ms, about 1100 ms, about 1200 ms,about 1300 ms, about 1400 ms, about 1500 ms, about 1600 ms, about 1700ms, about 1800 ms, about 1900 ms, about 2000 ms, about 2100 ms, about2200 ms, about 2300 ms, about 2400 ms, about 2500 ms, about 2600 ms,about 2700 ms, about 2800 ms, about 2900 ms, about 3000 ms, about 3100ms, about 3200 ms, about 3300 ms, about 3400 ms, about 3500 ms, about3600 ms, about 3700 ms, about 3800 ms, about 3900 ms, about 4000 ms, orthe like. Optionally stimuli luminance and/or intensity may be providedfrom about from 3.98×10⁻⁸ cd/m² up to about 3.98×10² cd/m².

Optionally and preferably the test protocol and stimulus sequence may bepresented to a subject in up to three sessions, optionally two sessionsand most preferably at least one sessions, as shown with directionalarrow 310.

Next following the completion of the test protocol where all stimulihave been presented over the specified visual field points to the testedeye and images of the PLR have been recorded (stage 304), in stage 305and 306 a processor, optionally in the form of computer 109, mayoptionally provide a decision support device utilized to abstract thevisual field map by determining a ratio of the PLR response of thesecond stimulus, long wavelength stimulus, in relation to the PLRresponse of the first stimuli, short wavelength stimulus. Mostpreferably PLR response is elucidated from video and image capture,provided by up to four cameras 106, utilized in stage 304 optionallywith dedicated software adept at determining the pupil constriction andsize. Most preferably the pupil constriction peak amplitude is thenutilized to determine the PLR ratio per visual field points tested.

Most preferably the visual field map is determined in stage 306 is basedon the recorded constriction results for each of the first and secondstimuli to produce a PLR ratio of the long to short wavelengths ratio.

Optionally and preferably the resulting visual field map may be storedfor later monitoring, decision support system diagnosis, and/or furtherprocessing.

Optionally any number of test protocol may be abstracted according tothe method of the present invention where a ratio is used to evaluateindividual visual field points for a number of animalize for exampleGlaucoma, RP, color blindness, color vision test or the like.

EXAMPLES

A preferred and optional embodiment of the present invention utilizingthe method described in FIG. 3 utilizing system 120 of FIG. 1A-B andtesting a visual field map comprising 13 visual field points, FIG. 2A,is described herein below with respect to Glaucoma and RP, indetermining a ratio, namely red to blue. Test protocol comprising atleast one and up to three stimuli sessions, as shown with directionalarrow 310, wherein the stimuli comprises at least two wavelengths tostimulate at least 13 visual field points (FIG. 2A) to simulated eacheye individually. Most preferably the wavelengths utilized comprise afirst long wavelength chromatic beam, in the red range, and a secondshort wavelength chromatic beam, in the blue range. Optionally the firstand second stimulus are presented in alternating fashion for each visualfield points at the outermost 30° visual field ring 208 and sequentiallytoward the central filed ring 202.

Optionally and more preferably the first stimuli may be a shortwavelength chromatic stimulus in the blue range, for example about 475nm, while the second stimuli may be a long wavelength chromatic stimulusin the red range, for example about 650 nm. Optionally the first stimulimay be a long wavelength chromatic stimulus in the red range, forexample about 650 nm, while the second stimuli may be a short wavelengthchromatic stimulus in the blue range, for example about 475 nm.

Optionally and preferably the stimulus characteristics of the firststimuli is about 480+19 nm, duration of about 1 s (one second);inter-stimuli delay of about 1023 ms (milliseconds) and intensity of3.98×10⁻⁸ cd/m². Optionally and preferably the stimulus characteristicsof the second stimuli is about 640+10 nm, duration of about 1 s (onesecond); inter-stimuli delay of about 891 ms (milliseconds) andintensity of 3.98×10⁻⁸ cd/m

The above test specification was utilized to determine the red/blueratio of normal, RP and Glaucoma subjects to evaluate the system andmethod according to optional embodiments of the present invention.

Example 1—Normal Subjects

The system and method described in FIGS. 1-3 was tested on subjectshaving a healthy eye, in total 25 eyes from 14 subjects were tested, 6females and 8 males, with a mean age 29.8 years. The stimulus providedas follows: first stimulus characteristics was a chromatic beam having awavelength of 480+19 nm, duration of about 1 s (one second), providedthree times; inter-stimuli delay of 1023 ms (milliseconds) and intensityof 3.98×10⁻⁸ cd/m²; and second stimulus characteristics was a chromaticbeam having a wavelength of 640+10 rim, duration of about 1 s (onesecond); inter-stimuli delay of 891 ms (milliseconds) and intensity of3.98×10⁻⁸ cd/m².

The visual field map was generated for both first and second stimuli,FIG. 4A shows the objective PLR response obtained with the secondstimuli, while FIG. 4B shows the objective PLR response obtained withthe first stimuli. Both FIGS. 4A and 4B show the respective populationpercentile score in 75^(th) percentile, 50^(th) percentile and 25^(th)percentile.

FIG. 4C shows the objective PLR response ratio obtained when comparingthe response to the second stimuli with the response to the firststimuli. The visual filed map of FIG. 4C shows that the 50^(th)percentile ratio is highest at the center of the visual filed is 0.5 andgradually reduces as the visual filed map extends to the 30° viewingangle. The results summarized and presented in Table 1 below:

TABLE 1 Normal ratio. Nasal Temporal Up Down Normal  0° 0.5 10° 0.410.45 0.48 0.43 20° 0.40 0.33 0.38 0.39 30° 0.5 0.44 0.5 0.4 RP  0° 0.510° 0.52 0.54 0.56 0.59 20° 0.53 0.62 0.71 0.42 30° 0.69 0.64 0.54 0.91

The ratio obtained in Normal healthy eyes according to the system andmethod of the present application provides a basis to which individualswith damaged eyes may be compared with.

Example 2—Retinitis Pigmentosa Subjects

The system and method described in FIGS. 1-3 was tested on subjects withdiagnosed Retinitis Pigmentosa (‘RT), in total 17 eyes were tested from11 subjects, 4 female and 7 male, with a mean age of 34.3 years. Thestimulus tested was as follows: first stimulus characteristics was achromatic beam having a wavelength of 480+19 nm, duration of about 1 s(one second), provided three times; inter-stimuli delay of 1023 ms(milliseconds) and intensity of 3.98×10⁻⁸ cd/m²; and second stimuluscharacteristics was a chromatic beam having a wavelength of 640+10 nm,duration of about 1 s (one second); inter-stimuli delay of 891 ms(milliseconds) and intensity of 3.98×10⁻⁸ cd/m².

The visual field map was generated for both first and second stimuli inall subjects, an example taken from one subject is provide in FIGS.5A-D. FIG. 5A shows the objective PLR response obtained with the secondstimuli, while FIG. 5B shows the objective PLR response obtained withthe first stimuli. The visual field maps obtained and displayed in FIGS.5A-B were then utilized to calculate a ratio for the tested subject anddisplayed in FIG. 5C. A comparison of FIG. 5C for a subject diagnosedwith RP with that of an otherwise health subject as shown in FIG. 5Cclearly identifies the problem areas within the visual field, markedwith a bold dashed line, that were shown to be significantly differentfrom the measurement of the normal subjects. Therefore the ratiocalculated according to the present invention provides a practitionerwith the ability to identify the specific problematic areas within thevisual field and possibly to isolate and provide treatment accordingly,not visible with the standard RP full field visual test.

Table 2 below provides a comparative table showing the visual fieldratios results of subjects with normal visions versus those diagnosedwith RP.

TABLE 2 Normal ratio vs. RP ratio. Nasal Temporal Up Down Normal  0° 0.510° 0.41 0.45 0.48 0.43 20° 0.40 0.33 0.38 0.39 30° 0.5 0.44 0.5 0.4 RP 0° 0.5 10° 0.52 0.54 0.56 0.59 20° 0.53 0.62 0.71 0.42 30° 0.69 0.640.54 0.91

The utility in adapting the ratio provided by the system and method ofthe present invention as a test for diagnosing subjects with RP isprovided in Table 3 below, showing that specificity and sensitivity ofthe objective ratio test produces promising results.

TABLE 3 Sensitivity and Specificity of Ratio test of Normal vs. RPsubjects Subjective VF Red/Blue Positive Negative Pupillometer Positive56 14 Based VF Negative 15 58 Sensitivity = 78.9% Specificity = 80.5%

The average of the PLR ratio in the normal subjects was 0.41+/−0.2(Average+SD). The average of the PLR ratio measurements of the patientsin the seeing area of the visual fields was 0.62+/−0.25 and in thenon-seeing area 0.97+0.2. The PLR ratio was significantly differentbetween the normal subject and the RP patients and between seeing areasand non-seeing areas in the visual fields of the RP patients (ANOVA,p<0.001).

Example 2—Glaucoma Patient

The system and method described in FIGS. 1-3 was tested on subjects withdiagnosed Glaucoma, in total 5 eyes were tested from 3 subjects, 1female and 2 male, with a mean age of 66.5 years. The stimulus testedwas as follows: first stimulus characteristics was a chromatic beamhaving a wavelength of 480+19 nm, duration of about 1 s (one second),provided three times; inter-stimuli delay of 1023 ms (milliseconds) andintensity of 3.98×10⁻⁸ cd/m²; and second stimulus characteristics was achromatic beam having a wavelength of 640+10 nm, duration of about 1 s(one second); inter-stimuli delay of 891 ms (milliseconds) and intensityof 3.98×10⁻⁸ cd/rn².

The visual field map was generated for both first and second stimuli inall subjects, an example taken from one subject is provided in FIGS.6A-D. FIG. 6A shows the objective PLR response obtained with the secondstimuli, while FIG. 6B shows the objective PLR response obtained withthe first stimuli. The visual field maps obtained and displayed in FIGS.6A-B were then utilized to calculate a ratio for the tested subject anddisplayed in FIG. 6C. A comparison of FIG. 6C for a subject diagnosedwith Glaucoma with that of an otherwise health subject as shown in FIG.6C clearly identifies the problem areas within the visual field, markedwith a bold dashed line, that were shown to be significantly differentfrom the measurement of the normal subjects, FIG. 4C. Therefore theratio calculated according to the present invention provides apractitioner with the ability to identify the specific problematic areaswithin the visual field and possibly to isolate and provide treatmentaccordingly.

FIG. 6D provides a comparative depictions showing the visual filed mapindependently obtained from a glaucoma subject superimposed with theratio determined according the system and method of the presentinvention as shown in FIG. 6C. The glaucoma subject's visual mapprovided by the gold standard test, is provided as a grayscale imagedepicting visual sensitivities of the retina in shades of gray. Areas ofvery poor retinal sensitivity are darkly shaded, and areas of goodretinal sensitivity are lightly shaded. The superimposed images, FIG.6D, of the two methods shows that areas where the ratio is significantlydifferent from the norm is indicative of a problem areas as the visualmaps correspond to one another. Specifically the lightly shaded areaindicating good retinal sensitivity is paralled in that the ratiodetermined for those visual filed spots is within the norm.

Accordingly, the method and system for determining the ratio of a longwavelength chromatic stimuli to a short wavelength chromatic stimuliprovides an improved way of diagnosing and elucidating an underlyingproblem within the eye anatomy, that provides a method for subjectivelytesting at least one eye.

While the invention has been described with respect to a limited numberof embodiment, it is to be realized that the optimum dimensionalrelationships for the parts of the invention, to include variations insize, materials, shape, form, function and manner of operation, assemblyand use, are deemed readily apparent and obvious to one skilled in theart, and all equivalent relationships to those illustrated in thedrawings and described in the specification are intended to beencompassed by the present invention.

Therefore, the foregoing is considered as illustrative only of theprinciples of the invention. Further, since numerous modifications andchanges will readily occur to those skilled in the art, it is notdescribed to limit the invention to the exact construction and operationshown and described and accordingly, all suitable modifications andequivalents may be resorted to, falling within the scope of theinvention.

Having described a specific preferred embodiment of the invention withreference to the accompanying drawings, it will be appreciated that thepresent invention is not limited to that precise embodiment and thatvarious changes and modifications can be effected therein by one ofordinary skill in the art without departing from the scope or spirit ofthe invention defined by the appended claims.

Further modifications of the invention will also occur to personsskilled in the art and all such are deemed to fall within the spirit andscope of the invention as defined by the appended claims.

While the invention has been described with respect to a limited numberof embodiments, it will be appreciated that many variations,modifications and other applications of the invention may be made.

The invention claimed is:
 1. A pupillometer system comprising: acomputer having a processor; at least one camera, wherein the at leastone camera is in communication with the computer; and a testingcompartment provided in the form of a substantially hemispheric bowl,wherein: the substantially hemispheric bowl comprises a plurality ofchromatic beam emitters arranged about a visual field forming aplurality of visual field testing points, the plurality of chromaticbeam emitters generate a plurality of stimuli about the plurality ofvisual field testing points, a first chromatic stimulus of the pluralityof stimuli stimulates a first anatomical structure comprising at leastone of the following: one or more ganglions, one or more rods, and oneor more cones, a second chromatic stimulus of the plurality of stimulistimulates a second anatomical structure comprising at least one of thefollowing: one or more ganglions, one or more rods, and one or morecones, wherein the first anatomical structure is different than thesecond anatomical structure, the at least one camera records a pupilresponse of one or more eyes in response to the first chromatic stimulusand the second chromatic stimulus, the processor controls the pluralityof chromatic beam emitters and one or more stimulus parameters of theplurality of chromatic beam emitters, the processor processes dataassociated with and generated by the first chromatic stimulus and thesecond chromatic stimulus and the at least one camera, and the processoris programmed to: generate quantitative pupillary light reflex (PLR)measurements of the PLR in response to the plurality of stimulipresented at the plurality of visual field testing points, determine atleast one PLR response ratio, wherein the at least one PLR responseratio is a relationship between a response measurement based on thefirst chromatic stimulus generated by at least one visual field testingpoint of the plurality of visual field testing points and a responsemeasurement based on the second chromatic stimulus generated by at leastone visual field testing point of the plurality of visual field testingpoints, and determine a state of health of the one or more eyesutilizing the at least one PLR response ratio.
 2. The pupillometersystem of claim 1, wherein the processor further determines two PLRresponse ratios, a first PLR response ratio comprises a ratio of atleast one of the following: rods to ganglions, ganglions to rods, conesto ganglions, ganglions to cones, rods to cones, and cones to rods, anda second PLR response ratio comprises a ratio of at least one or thefollowing: rods to ganglions, ganglions to rods, cones to ganglions,ganglions to cones, rods to cones, and cones to rods, and determines thestate of health of the one or more eyes utilizing the first PLR responseratio and the second PLR response ratio, wherein the first PLR responseratio and the second PLR response ratio each comprise a ratio having acommon denominator.
 3. The pupillometer system of claim 2, wherein thefirst PLR response ratio comprises a ratio of rods to ganglions and thesecond PLR response ratio comprises a ratio of cones to ganglions. 4.The pupillometer system of claim 1, wherein the one or more stimulusparameters comprise at least one of the following a wavelength, aduration, a delay, an intensity, a luminance, a shape, and a size of theplurality of chromatic beam emitters.
 5. The pupillometer system ofclaim 4, wherein the plurality of chromatic beam emitters generate theplurality of stimuli for the duration of between about 0.1 seconds toabout 4 seconds.
 6. The pupillometer system of claim 4, wherein theplurality of chromatic beam emitters generate the plurality of stimuliwith the luminance between about 3.98×10⁻⁸ cd/m² to about 3.98×10²cd/m².
 7. The pupillometer system of claim 4, wherein the plurality ofchromatic beam emitters generate the plurality of stimuli with thewavelength from a visual spectrum spanning between about 390 nm to about750 nm.
 8. The pupillometer system of claim 4, wherein the plurality ofchromatic beam emitters generate the plurality of stimuli are providedwith a size of about 0.05 cm to about 2 cm in diameter.
 9. Thepupillometer system of claim 1, wherein the first chromatic stimulus ofthe plurality of stimuli stimulates a region of the one or more eyesutilizing two or more visual field testing points of the plurality ofvisual field testing points.
 10. The pupillometer system of claim 9,wherein the determined the state of health of the one or more eyesidentifies a problematic region within the visual field of the one ormore eyes.
 11. The pupillometer system of claim 1, further comprises oneor more fixation points disposed on an inner surface of thesubstantially hemispheric bowl opposite a subject's line of sight. 12.The pupillometer system of claim 11, wherein up to four fixation pointsare disposed on the inner surface of the substantially hemispheric bowl.13. The pupillometer system of claim 1, wherein up to four cameras areutilized to record the pupil response in response to the first chromaticstimulus and the second chromatic stimulus.
 14. The pupillometer systemof claim 1, wherein the at least one PLR response ratio is mapped to thevisual field.
 15. The pupillometer system of claim 1, further comprisinga controllable shutter for controlling the size or shape of thegenerated stimulus.
 16. The pupillometer system of claim 15, wherein ashutter size corresponds to a stimulus having a substantially circularformation with a diameter from about 0.05 cm to about 2 cm.
 17. Thepupillometer system of claim 1, wherein both eyes are testedsimultaneously.
 18. The pupillometer system of claim 1, wherein botheyes are tested one at a time.
 19. The pupillometer system of claim 1,wherein the computer is a smart phone.
 20. The pupillometer system ofclaim 1, wherein the computer includes a decision support tool whereinthe decision support tool provides assistance in analyzing anddetermining the state of health of the one or more eyes.